A FierceHealthcare story discusses a third option for physicians between becoming a hospital employee and staying completely independent.

It’s called the group practice subsidiary (GPS) model, as explained by lawyer Curt Chase, J.D., a partner at Husch Blackwell LLP in Kansas City, Mo., during a presentation at the Medical Group Management Association annual conference.

Fierce reported: “The emerging model integrates independent practices with hospitals and healthcare systems while allowing physicians to keep their independence, Chase said. Rather than a hospital or health system owning a practice, it creates a subsidiary which employs the physician practice. The doctors are not employed by the hospital, but the hospital owns the subsidiary although it doesn’t subsidize it. The hospital has a certain level of control but the practice continues to operate much like it did before.

“For hospitals, the model provides a broader physician network, better positions them to work with community physicians to manage population health and gives them strategic, long-term affiliations with doctors.”

A bipartisan group has introduced a bill in the U.S. House that would apparently let the U.S. Department of Health and Human Services (HHS) ease the burden on hospitals (apparently hospitals only) of Meaningful Use rules involving Medicare recipients.

Called an effort to “amend title XVIII of the Social Security Act to reduce the volume of future electronic health-related significant hardship requests,” the bill would only affect providers still subject to the government’s electronic health record (EHR) incentive program, known as ‘Meaningful Use,”’ Robert Tennant, senior policy adviser to the Medical Group Management Association, told Medscape.

CMS no longer requires individual physicians to participate in the Meaningful Use program, which for them has been subsumed by the Quality Payment Program (QPP) of the Centers for Medicare and Medicaid Services. And, Mr. Tennant said, physicians eligible to participate in the Medicaid portion of Meaningful Use are not penalized if they don’t participate.

He explained that the legislation might ease their Meaningful Use reporting, but any hardship exceptions would not affect them.

The Centers for Medicare & Medicaid Services wants to expand the model called Comprehensive Primary Care Plus. But an adjustment in how some providers are reimbursed in it could discourage providers from joining, reports Modern Healthcare.

The agency will gather providers into two groups, with “one receiving CPC Plus payments such as care-management fees, performance-based incentive payments or comprehensive primary-care payments, while the other will not,” reported the publication.Paul Ginsburg, a professor of health policy and management at the University of Southern California, told Modern Healthcare that the change would make federal attempts to evaluate CPC Plus stronger, but will lead to less participation.

“And there are questions about whether the randomized version of CPC Plus will still count as an alternative pay model under the Medicare Access and CHIP Reauthorization Act.” the publication reported.

Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, that would be a huge disincentive to providers.

Still, the struggle to win providers could be less to do with CPC Plus itself, and more with the information overload of alternative pay models in recent years, David Introcaso, AMGA’s senior director of regulatory and public policy, told Modern Healthcare.

In this video, Halee S. Fischer-Wright, president and CEO of the Medical Group Management Association (MGMA), discusses how small medical practices can survive now that the environment for running medical practices a decade ago “no longer applies.” She calls for physician owners to be more involved in the business side of their practice.

Data from the Centers for Medicare & Medicaid Services show that few provider practices benefited from the agency’s Value-Based Payment Modifier program.

13,813 physician groups were eligible to compete for the pay bump, but only 128 group practices will see their Medicare reimbursement rise by 16 percent or 32 percent, with the higher percentage going to practices with the most high-risk patients.

The fact that so few practices benefit from VBM could indicate an inherent flaw in the program’s methodology, Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, told Modern Healthcare.

“These results show that getting a reimbursement increase is akin to winning the lottery. This just isn’t a meaningful system.”

The study found that 12.5 hours of physician and staff time per physician per week was spent on entering information into the medical record solely to report for quality measures from external entities.

“There is much to gain from quality measurement, but the current system is far from being efficient and contributes to negative physician attitudes toward quality measures,” the authors wrote.

Halee Fischer-Wright, M.D., president and CEO of the Medical Group Management Association, said of the research: “This study proves that the current top-down approach has failed. It serves no purpose to have over 3,000 competing measures of quality across government and private initiatives. Although standardization is critical, if measures don’t improve patient care, it’s an exercise in futility. As the largest contributor to the problem, the federal government needs to get out of the business of dictating patient care through wasteful mandates and create simplified systems to support medical practices in improving quality across the country.”

The MIPS combines parts of the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier, and Meaningful Use into one single program based on quality, resource use and clinical-practice improvement.

Robert Tennant, senior policy adviser with the Medical Group Management Association (MGMA), told MedPage Today that the two programs are very inter-twined:

“Even though Meaningful Use was sunsetted, it’s now effectively 25% of your MIPS score, so it never really goes away.” And because it is so much of the MIPS score, “it’s potentially more impactful on your reimbursement.”

But Linda Delo, D.O., a family physician in Port Saint Lucie, Fla., told the online news service that, as MedPage paraphrased her, “{P]hysicians can get out from under MIPS in some cases if they become part of an alternative payment model such as an Accountable Care Organization (ACO), a bundled payment model, or a patient-centered medical home (PCMH), rather than continue in the traditional fee-for-service Medicare program.”

“The latest Workgroup for Electronic Data Interchange (WEDI) survey also found that only about 20 percent of physician practices have started or completed external testing. That percentage is up from the 10 percent of physicians who said they had done external testing in results released in March.”

Robert Tennant, vice chairman of the WEDI group and government affairs senior policy adviser for the Medical Group Management Association, told Medscape that the survey indicates big trouble.

“The physician side of the provider community — they’re really struggling,” Tennant said. “I think the government has not done a very good job about explaining the return on investment for physicians; it’s not clear at all why we’re doing this.”

“Also, many are at the mercy of their software vendors,” he said, noting that if the software isn’t up to date, physicians can’t submit the codes or test the systems.

“What that tells us in the industry is that we’re looking at potentially a healthcare.gov situation, where the light switch is flipped and things don’t work,” he said.

Primary-care physicians reported a median compensation of $241,273 in 2014, up 3.56 percent from 2013. Median compensation for other physicians rose to $411,852, up 2.39 percent.

(The median household income in the U.S. is about $50,000.)

“The role of the primary-care physician continues to be a linchpin with the new healthcare models,” Todd Evenson, MGMA chief operating officer, told MedPage Today. “Obviously hospitals are playing a role hiring at a brisk pace, strengthening their referral networks and trying to ensure that they can deliver on a quality-based model.”

He also said:

“In 2012 our survey showed on average that 6.67 percent of compensation for primary-care physicians was based on quality measures. In 2014 that had already migrated to 10.83 percent for primary care. On the specialty side, it was 4.6 percent in 2013 and 7.3 percent in 2014. This clearly indicates that the quality component is becoming a larger factor.”

In 2012 50 percent of respondents said that their compensation was 100 percent productivity-based (i.e., “fee for service”). But in 2014 only 25 percent of respondents said their pay was totally fee for service..”That shift is pretty sizable in terms of the composition of these compensation plans aligning with value measures, and reflects what is going on in these reimbursement models,” Mr. Everson said.